It is an undeniable fact that individuals with chronic pain have a higher prevalence rate of suicide than the general population.
Tang and Crane (2006) summarized the results of 12 articles examining correlations between suicide and chronic pain, concluding that individuals with chronic pain are twice as likely to die by suicide than the general population. More specifically, approximately 5-14% of individuals with chronic pain attempt suicide, and about 20% report some level of suicidal ideation.
One of my counseling clients who has experienced chronic pain for the past three years recently told me, “I keep praying that God will take me home as I sleep. I would never kill myself, but I just need a break.” In my work as a counselor, I have found that passive suicidal thoughts such as these are the norm among individuals undergoing constant physical suffering.
Although I have never contemplated suicide, my own experience with chronic pain has been eye-opening regarding how people can get to the place of either active or passive suicidal thoughts. Before pain, the thought of suicide seemed foreign and strange. After dealing with long periods of uncontrolled pain, it is not hard for me to see how people find themselves in a place of hopeless that drifts into suicidal intentions.
I am currently reading a book entitled Myths About Suicide by Thomas Joiner, and it has been eye-opening in understanding some of the finer nuances of why individuals with pain and illness die by suicide. Joiner’s theory is that individuals die by suicide due to the merging of three key factors in their lives: perceived burdensomeness, failed belongingness, and learned fearlessness.
When these three factors converge, individuals are able to move past the ingrained human desire for self-preservation to a place in which death is no longer feared. Not only is death no longer feared, but it becomes seen as a better option than life.
As I considered these three factors, it became apparent why suicide is such an immense risk for individuals facing severe and ongoing illness and pain.
Factor #1: Perceived Burdensomeness
Most individuals with pain or illness feel like a burden. There are so many things we can no longer do and so many tasks others must take over for us. Perhaps we can no longer work and contribute financially. Perhaps, we can’t get around on our own and need constant and close caretaking. Wherever we fall on the spectrum of disability, we can’t shake the feeling that we are burdensome to our families and our friends.
When this feeling of burdensomeness becomes strong enough, individuals begin weighing the costs and benefits of life versus death in terms of how it will affect family and loved ones. They begin to wonder, “Would it be more beneficial for the people around me if I were dead than my current state of being alive?”
Factor #2: Failed Belongingness
Many individuals with severe pain and illness struggle to maintain a sense of belongingness. Joiner describes failed belongingness as “the feeling that one is alienated from others and not an integral part of a family, circle of friends, or other valued group” (Joiner, 2011).
This sense of alienation happens for many reasons among individuals with severe pain and illness. Perhaps most significantly, moving into community becomes difficult to impossible when physical limitations leave individuals bedbound, homebound, or severely limited in their mobility. Many times, groups of people are centered around activities, and those with pain and illness become alienated because they are no longer able to engage in activities that once made them feel as though they belonged.
Friends leave, families drift away, and it becomes difficult to find people to relate to when you aren’t up and doing what everyone else is doing.
Factor #3: Learned Fearlessness
Learned fearlessness is a process of habituation that occurs when individuals go through long-term painful situations.
Joiner explains it this way: “past experience with injury, pain, and the like creates a familiarity and fearlessness, which, if combined with desire for death, can prove fatal” (p. 21).
Individuals with severe pain and illness have no choice but to become acquainted with injury and pain. There is no possible way not to experience it. Over and over again, they are desensitized to physical suffering. The thought of death begins to lose its terror because they have faced so many physical terrors already. In the end, severe and unending pain and illness lead to an erosion of the natural fear of dying.
Some Possible Solutions
Here are some of my initial thoughts on what all this might mean for prevention of suicide among individuals with pain and illness.
When it comes to learned fearlessness, individuals with chronic pain and illness need real relief from their physical and emotional suffering. The process of habituation that occurs due to sustained exposure to severely undermanaged pain and symptoms can often be avoided, to some extent, if physical pain is taken seriously. Patients with pain and illness need doctors and nurses and other medical professionals to believe their pain is real and believe it is actually as bad as they say it is.
They need counselors and friends who will walk with them through their emotional pain, recognizing it as a real and important issue, but not blaming their pain on their emotional status.
They need pain management options and doctors who are willing to try over and over again to bring sustained relief. Individuals with severe pain need opioids and other medicines that are often stigmatized, and they need to be able to take them without being labeled addicts.
Anecdotal evidence reported by the Pain News Network suggests that the new CDC opioid guidelines could be leading to an increase in deaths by suicide among individuals with chronic pain. According to the Pain News Network, many of their readers have written in, explaining that their doctors have decreased or cut off treatment, leading some of them to consider suicide as a better option than years of uncontrolled pain. Something needs to be done.
When it comes to failed belongingness, individuals with chronic pain and illness need real community to welcome them in. Community is so hard to find for individuals with severe pain and illness.
Sometimes it is impossible for them to go into community, and they desperately need community to come to them. They need family, friends, church members, anyone who is willing, to come and be with them.
An acquaintance once approached me several years ago and asked if I needed help with anything. Did I need help getting to doctor’s appointments? Someone to clean my house? Could they do anything for me? I responded that what I actually really needed at that time was company. Would they be willing to come visit me because I was feeling incredibly isolated and unable to get out and be around people. My schedule was flexible, and they could let me know a good time for them.
It was so strange. The moment I asked for this kind of help, the conversation stopped. They never followed up, never said anything further about my request.
Perhaps this was because visiting someone doesn’t necessarily seem like offering help. But it is. It may be the most important thing that can be offered to people isolated because of physical pain and symptoms.
People with severe pain and illness need relief from suffering, but more importantly they need people who will walk with them through their suffering that will not be going away.
When it comes to perceived burdensomeness, individuals with chronic pain and illness need to believe their value does not come from what they are able to do or contribute.
In considering burdensomeness, I think it is important to recognize that burdens do exists. Yes, sometimes we perceive ourselves as burdensome when this is not the case. But, if we are going to deal with this topic honestly, we have to recognize that our pain represents a cost to the people around us.
Yet here is the important difference. You carry a great burden, but you are not a burden. A burden is not who you are, it does not define you. It does not determine your value or your worth.
Every single person who has ever lived will carry burdens, and some people must carry bigger burdens than others. So often we devalue people who carry bigger burdens, when really our response should be to carry one another’s burdens in love, each of us using the measure of strength we have been given. We carry each other’s burdens because this is part of who we were created to be – those who serve one another in love.
And we do this back and forth, for each other. Those who are healthy do what those who are sick cannot. Those who are sick care for their caretakers as well, proving a listening ear, showing interest in their life, looking out for their needs, and encouraging them to ask for help.
If you are considering suicide, know that the people around you would not be better off without you. Who you are is not measured by how much you are able to accomplish or do. From the moment you were born, you were filled with great value and great worth, given to you by God that can never be taken away, no matter how bad the pain becomes, no matter how long the pain persists.
If you are experiencing suicidal thoughts, please call The National Suicide Hotline at 1-800-273-8255.
Joiner, T. (2011) Myths About Suicide. Cambridge, MA: Harvard University Press
Tang N. K. Y. and Crane, C. (2006). Suicidality in chronic pain: A review of prevalence, risk factors, and psychological links. Psychological Medicine, 36(5), 575-586.
Check out the first booklet in the Chronic Pain and the Christian Life series, But God Wouldn’t I Be More Useful to You If I Were Healthy, on Amazon.com.